Scammed by PetPlan. Anyone else?

JR_Ryan

So, the short version of this post is: I have an otherwise very healthy 15-year-old lab with 15-year-old lab problems, and PetPlan has decided that being old is a disqualifying factor for paying out.

Now here's the long story...

A couple of months ago my beautiful and healthy 15-year-old lab took a severe turn for the worse; kidney failure. It was incredibly bad timing as my mother had just gone in for an unexpected emergency open-heart surgery, which later turned into a cancer diagnosis, and my partner was scheduled to go in for a knee replacement in a matter of days. Being a responsible pet parent, I thought, "no worries, I have paid thousands into our insurance, and it's finally time to claim for something." I did once claim for a tooth extraction, but that is the only other claim I have made in 15 years.

On the advice of our family vet, I admitted her into an overnight emergency vet where she stayed for 4 days on a drip, slowly getting better. We brought her home, and with a new diet, she has improved to the extent that her kidney indicator levels are only slightly elevated, and I filed a direct claim with PetPlan. Subsequently, she has had some other issues, not necessarily connected, but exacerbated by the trauma (inflamed arthritis in her back and hips, a persistent UTI, and most recently, a stroke).

Again, "No matter," I thought, "My insurance will pay for the primary care up to £2000, and the complementary treatments up to a grand." These follow on visits were not direct claims, so I paid them out of pocket, with some help for family as I'm poor, but not poor enough to be on benefits, and my credit is too bad to own a credit card.

Then I got a letter from the insurance company: Claim denied. Nearly £1000 for the kidney problem is now my problem to deal with, and I'm already tapped out from the other treatments, not to mention the additional costs of travelling and caring for three poorly ladies across 4 separate parts of the country.

The claim was turned down on the basis that in 2017 my dog had a single treatment for UTI and was prescribed antibiotics which cleared it up in a matter of days. Dogs with kidney disease can be susceptible to UTI's, but not the other way around, and she did not have kidney disease at that point as a scan at the time was taken and proves that. So, I asked my vet to write a letter to PetPlan in support of my appeal, and the underwriters have stuck to their guns. I am in the process now of making a formal complaint, waiting for their official final decision, and involving the financial ombudsman.

Kidney disease in dogs is pretty rare, mostly because many dogs don't live long enough to get it. It is, in a way, a testament to just how healthy my girl is that she has it at all. Basically, after 15 years, her kidneys are just worn out. As I see it, their reasoning for denying the claim is essentially that she's too old to insure. Now, since speaking to them about this, it has become apparent that there is a whole list of additional exclusions that have been added on to my policy over the last 2-3 years, excluding coverage for anything to do with the reproductive system, urinary tract, hips back and legs, mouth disorders, and anything to do with cardiopulmonary, respiratory, or neurologic disorders. So, pretty much everything is excluded. If I had simply put the money I spent on this policy into a savings account, I would have had all the money I needed to cover any procedure outright.

I feel like I've been scammed, and at my lowest point no less. I'm really stuck, in a number of different ways, but I just wanted to see if anyone else has had an experience like this with PetPlan, and if you did, were you able to turn the tide in your favour?

Undervalued

JR_Ryan wrote: »

So, the short version of this post is: I have an otherwise very healthy 15-year-old lab with 15-year-old lab problems, and PetPlan has decided that being old is a disqualifying factor for paying out.

Now here's the long story...

A couple of months ago my beautiful and healthy 15-year-old lab took a severe turn for the worse; kidney failure. It was incredibly bad timing as my mother had just gone in for an unexpected emergency open-heart surgery, which later turned into a cancer diagnosis, and my partner was scheduled to go in for a knee replacement in a matter of days. Being a responsible pet parent, I thought, "no worries, I have paid thousands into our insurance, and it's finally time to claim for something." I did once claim for a tooth extraction, but that is the only other claim I have made in 15 years.

On the advice of our family vet, I admitted her into an overnight emergency vet where she stayed for 4 days on a drip, slowly getting better. We brought her home, and with a new diet, she has improved to the extent that her kidney indicator levels are only slightly elevated, and I filed a direct claim with PetPlan. Subsequently, she has had some other issues, not necessarily connected, but exacerbated by the trauma (inflamed arthritis in her back and hips, a persistent UTI, and most recently, a stroke).

Again, "No matter," I thought, "My insurance will pay for the primary care up to £2000, and the complementary treatments up to a grand." These follow on visits were not direct claims, so I paid them out of pocket, with some help for family as I'm poor, but not poor enough to be on benefits, and my credit is too bad to own a credit card.

Then I got a letter from the insurance company: Claim denied. Nearly £1000 for the kidney problem is now my problem to deal with, and I'm already tapped out from the other treatments, not to mention the additional costs of travelling and caring for three poorly ladies across 4 separate parts of the country.

The claim was turned down on the basis that in 2017 my dog had a single treatment for UTI and was prescribed antibiotics which cleared it up in a matter of days. Dogs with kidney disease can be susceptible to UTI's, but not the other way around, and she did not have kidney disease at that point as a scan at the time was taken and proves that. So, I asked my vet to write a letter to PetPlan in support of my appeal, and the underwriters have stuck to their guns. I am in the process now of making a formal complaint, waiting for their official final decision, and involving the financial ombudsman.

Kidney disease in dogs is pretty rare, mostly because many dogs don't live long enough to get it. It is, in a way, a testament to just how healthy my girl is that she has it at all. Basically, after 15 years, her kidneys are just worn out. As I see it, their reasoning for denying the claim is essentially that she's too old to insure. Now, since speaking to them about this, it has become apparent that there is a whole list of additional exclusions that have been added on to my policy over the last 2-3 years, excluding coverage for anything to do with the reproductive system, urinary tract, hips back and legs, mouth disorders, and anything to do with cardiopulmonary, respiratory, or neurologic disorders. So, pretty much everything is excluded. If I had simply put the money I spent on this policy into a savings account, I would have had all the money I needed to cover any procedure outright.

I feel like I've been scammed, and at my lowest point no less. I'm really stuck, in a number of different ways, but I just wanted to see if anyone else has had an experience like this with PetPlan, and if you did, were you able to turn the tide in your favour?

You did of course read all of the renewal paperwork carefully to make sure you were happy with the level of cover on offer? It was your choice to renew, you had the option of deciding that the policy didn't offer value for money and looking elsewhere or, as you mention, putting the money to one side and "self insuring".

Advice4sue

I’m so sorry you have this problem but if all those exclusions are on your policy, then I suspect they won’t back down.
We are all busy people and this is a reminder to us all to check the policy wording at every renewal. I’m guilty of not doing that.
PetPlan always had a good reputation to pay out ( hence their high premiums). You have paid your high premiums in good faith. So I absolutely understand you are up upset but I have a horrible feeling you have a battle on your hands.

But keep plugging away, as having worked in insurance years ago, I recall that there can sometimes be flexibility! But sadly I don’t think it will be easy.
Your post has confirmed my opinion to review my dogs insurance.

Best wishes for you and your dog. I hope you can find a way through

JR_Ryan

Undervalued wrote: »

You did of course read all of the renewal paperwork carefully to make sure you were happy with the level of cover on offer? It was your choice to renew, you had the option of deciding that the policy didn't offer value for money and looking elsewhere or, as you mention, putting the money to one side and "self insuring".

I am, no doubt, naive in the eyes of many for not realising that I was playing the insurance company's three-card monty. Funnily, as my premiums rose to double my car insurance, I never assumed that my cover would become essentially worthless.

No, I didn't "of course" keep on top of the exclusions as they were added into my automatic renewal, clearly, but I still acted in good faith, which is more than I can say for PetPlan. You might be right to point out the harsh contractual truth of the matter, but the law has made it clear that businesses cannot misrepresent their products, confuse their clients into purchasing said products, nor sell worthless goods for costs and promises that would indicate value where there is none.

And like every good scam, it's a two-party grift. Not to paint the whole industry with too broad a brush, but some vets won't even treat an animal without insurance, and if they do, there is so much guilt and pressure to be insured. So, what is a person to do? Roll over and take it? I have seen so many stories of loving and responsible pet owners being stuck with huge bills for major issues that aren't covered by the protection they thought they had. How is this still going on, when PPI was nipped in the bud after only a few years?

I do appreciate your response, thank you. It's just a very raw topic for me right now to be overly polite with such direct sentiments.

JR_Ryan

Advice4sue wrote: »

I’m so sorry you have this problem but if all those exclusions are on your policy, then I suspect they won’t back down.
We are all busy people and this is a reminder to us all to check the policy wording at every renewal. I’m guilty of not doing that.
PetPlan always had a good reputation to pay out ( hence their high premiums). You have paid your high premiums in good faith. So I absolutely understand you are up upset but I have a horrible feeling you have a battle on your hands.

But keep plugging away, as having worked in insurance years ago, I recall that there can sometimes be flexibility! But sadly I don’t think it will be easy.
Your post has confirmed my opinion to review my dogs insurance.

Best wishes for you and your dog. I hope you can find a way through

Thank you very much for your kind words and thoughts, much appreciated. I will take it to the ombudsman, and try my best to get it into the public domain as well. I can't be the only one affected by this sort of disingenuous and cynical business practice. As some of my family are fond of saying, I'll Keep !!!!!!ing On. One thing is for sure, if I ever have another pet, I will insure them, but I will also put the difference between the young premiums and what I'm paying now into a bank account, and !!! soon as the exclusions start to be added to the policy I will cancel it outright and just save. And who knows? Maybe this becomes the norm and insurance companies will see how damaging their own practices are to "their customers" and they will lose enough revenue to change their ways. Anyway, thanks again for your support.

Undervalued

JR_Ryan wrote: »

I am, no doubt, naive in the eyes of many for not realising that I was playing the insurance company's three-card monty. Funnily, as my premiums rose to double my car insurance, I never assumed that my cover would become essentially worthless.

No, I didn't "of course" keep on top of the exclusions as they were added into my automatic renewal, clearly, but I still acted in good faith, which is more than I can say for PetPlan. You might be right to point out the harsh contractual truth of the matter, but the law has made it clear that businesses cannot misrepresent their products, confuse their clients into purchasing said products, nor sell worthless goods for costs and promises that would indicate value where there is none.

And like every good scam, it's a two-party grift. Not to paint the whole industry with too broad a brush, but some vets won't even treat an animal without insurance, and if they do, there is so much guilt and pressure to be insured. So, what is a person to do? Roll over and take it? I have seen so many stories of loving and responsible pet owners being stuck with huge bills for major issues that aren't covered by the protection they thought they had. How is this still going on, when PPI was nipped in the bud after only a few years?

I do appreciate your response, thank you. It's just a very raw topic for me right now to be overly polite with such direct sentiments.

I can't say whether they did or didn't "misrepresent their products" in your particular case. If you genuinely feel they did then obviously you should complain and, if necessary, progress it to the ombudsman.

My general point however stands. It is vital to understand the terms of any contract you enter into and this includes insurance, perhaps especially pet insurance.

As I understand it the owner can sometimes be in a position where decisions have to be made quickly about a course of treatment, before the insurance company can assess whether their claim is valid. It must also place the vet in a very difficult position as it is not for them to advise if a particular insurance company is likely to pay out.

A vet has a legal duty to provide emergency first aid (or if appropriate end the animal's suffering) even if there is nobody to pay the bill. Beyond that they have to earn a living in a exceptionally demanding profession with ever increasing costs and expectations.

Faith177

JR_Ryan wrote: »

I am, no doubt, naive in the eyes of many for not realising that I was playing the insurance company's three-card monty. Funnily, as my premiums rose to double my car insurance, I never assumed that my cover would become essentially worthless.

No, I didn't "of course" keep on top of the exclusions as they were added into my automatic renewal, clearly, but I still acted in good faith, which is more than I can say for PetPlan. You might be right to point out the harsh contractual truth of the matter, but the law has made it clear that businesses cannot misrepresent their products, confuse their clients into purchasing said products, nor sell worthless goods for costs and promises that would indicate value where there is none.

And like every good scam, it's a two-party grift. Not to paint the whole industry with too broad a brush, but some vets won't even treat an animal without insurance, and if they do, there is so much guilt and pressure to be insured. So, what is a person to do? Roll over and take it? I have seen so many stories of loving and responsible pet owners being stuck with huge bills for major issues that aren't covered by the protection they thought they had. How is this still going on, when PPI was nipped in the bud after only a few years?

I do appreciate your response, thank you. It's just a very raw topic for me right now to be overly polite with such direct sentiments.

But they didn’t mislead or confuse you they put it on their documents you choose not to read it. It’s not worthless because there are some things you could claim for

It’s pretty common knowledge that as the pet gets old less is covered and the cover is more expensive as the likely hood of you claiming is higher

Sorry OP but this is on you no scam at all

sheramber

Do you have a lifetime policy or a 12 month policy.?

If conditions are excluded then it sounds like a limited time policy and
you only have cover for 12 months from diagnosis.

Anything that can be related to an excluded condition will also be excluded.

https://www.petplan.co.uk/dog-insurance/

JR_Ryan

Undervalued wrote: »

I can't say whether they did or didn't "misrepresent their products" in your particular case. If you genuinely feel they did then obviously you should complain and, if necessary, progress it to the ombudsman.

My general point however stands. It is vital to understand the terms of any contract you enter into and this includes insurance, perhaps especially pet insurance.

As I understand it the owner can sometimes be in a position where decisions have to be made quickly about a course of treatment, before the insurance company can assess whether their claim is valid. It must also place the vet in a very difficult position as it is not for them to advise if a particular insurance company is likely to pay out.

A vet has a legal duty to provide emergency first aid (or if appropriate end the animal's suffering) even if there is nobody to pay the bill. Beyond that they have to earn a living in a exceptionally demanding profession with ever increasing costs and expectations.

I absolutely respect and admire my vets, and I count them as allies in this fight. But the industry is set up in such a way that the two hands wash each other. Exactly the same as the American Medical industry, and we all know how terrible that is. Good health and service for those that can afford it, debt and an early death for those that can't. And all the while the costs of medicines increase and increase as the hospitals and insurance companies fix the rates they want like a libor.

Faith177 wrote: »

But they didn’t mislead or confuse you they put it on their documents you choose not to read it. It’s not worthless because there are some things you could claim for

It’s pretty common knowledge that as the pet gets old less is covered and the cover is more expensive as the likely hood of you claiming is higher

Sorry OP but this is on you no scam at all

Who are you to tell me they didn't mislead and confuse me if I say that I feel misled and confused? What kind of gaslighting is that? Maybe you could tell me another industry where the consumer pays more for less.

sheramber wrote: »

Do you have a lifetime policy or a 12 month policy.?

If conditions are excluded then it sounds like a limited time policy and
you only have cover for 12 months from diagnosis.

Anything that can be related to an excluded condition will also be excluded.

It's a 12 month policy, as I have always had to be thrifty with money, but even if I wanted to switch to lifetime coverage, I needed to do so before her 8th birthday as they won't allow you to begin a lifetime policy after that, effectively excluding elderly dogs from full coverage.

Also, the 12 month clock doesn't start from diagnosis, it starts from the first point any symptoms of the condition were noticed. So, if my dog was diagnosed with arthritis and I said "she's been stiff for 3 months now" the insurance company will start the clock retroactively from the specific number of months prior to diagnosis that I or my vet would list in the case notes/claim form. And if I said, just as an example, that she has been stiff for over a year, but not enough to warrant veterinary care, then the claim would be rejected outright.

And, you are right, anything related, no matter how tenuously, and for my list of exceptions, that's pretty much everything.

Faith177

JR_Ryan wrote: »

I absolutely respect and admire my vets, and I count them as allies in this fight. But the industry is set up in such a way that the two hands wash each other. Exactly the same as the American Medical industry, and we all know how terrible that is. Good health and service for those that can afford it, debt and an early death for those that can't. And all the while the costs of medicines increase and increase as the hospitals and insurance companies fix the rates they want like a libor.



Who are you to tell me they didn't mislead and confuse me if I say that I feel misled and confused? What kind of gaslighting is that? Maybe you could tell me another industry where the consumer pays more for less.



It's a 12 month policy, as I have always had to be thrifty with money, but even if I wanted to switch to lifetime coverage, I needed to do so before her 8th birthday as they won't allow you to begin a lifetime policy after that, effectively excluding elderly dogs from full coverage.

Also, the 12 month clock doesn't start from diagnosis, it starts from the first point any symptoms of the condition were noticed. So, if my dog was diagnosed with arthritis and I said "she's been stiff for 3 months now" the insurance company will start the clock retroactively from the specific number of months prior to diagnosis that I or my vet would list in the case notes/claim form. And if I said, just as an example, that she has been stiff for over a year, but not enough to warrant veterinary care, then the claim would be rejected outright.

And, you are right, anything related, no matter how tenuously, and for my list of exceptions, that's pretty much everything.

You came on a public forum asking for advice I gave you my honest opinion based on years of pet ownership nothing more. Don’t want people’s opinions don’t put things on the internet

No “gaslighting” involved but if that’s what you want to believe that’s fine by me!

You are paying more because the risk is greater it is really that simple most pet insurers operate in exactly the same manner

Undervalued

Faith177 wrote: »

You came on a public forum asking for advice I gave you my honest opinion based on years of pet ownership nothing more. Don’t want people’s opinions don’t put things on the internet

No “gaslighting” involved but if that’s what you want to believe that’s fine by me!

You are paying more because the risk is greater it is really that simple most pet insurers operate in exactly the same manner

Quite!

Legally, insuring a pet is no different to insuring any other possession (which is what a pet is in law). You choose a policy that provides the cover you want and you should take the trouble to understand the terms, conditions and exclusions.

If you have a valid claim the insurers should pay up. If they don't you have free recourse to the ombudsman which it where it seems this is heading.

The emotional aspects of "poor Fido" or the financial circumstances of the policy holder have nothing to do with rights and wrongs of the decision to refuse a claim.